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FOR OFFICF USE:I I - " 1 � ,______ __--------------_____-------------- APPLICATION FOR SANITATION PERMIT Permit No: .. ..... ...... .. ----------- --------------------------------------------- (Complete in Duplicate) -------Date �JJ . . ----:--- This Permit Ex ires 1`'Year`From Date Issued Issued ------------ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance N . 549. JOB ADDRESS AN L CATION-------------------------- - = - Owners Name__.. �J1,L0, L..___.... ____________________________h_____-...--.--__-.___________-_.___-___._____3_:'' Phone..........................._-....... Address------------- --- _ Phon Contractor's Name-----k -• ---.h.(�' -' it l icF f - e Installation will serve: Residence [D/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms --k Number o baths _ l ---- -- Lot size ..._c��_�._/�_......-•-•------------------------•-- Water Supply: Public system 0` Community system ❑ Private ❑ Depth to Water Table _�ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Oay ❑ Adobe Ms —Hardpan ❑ I. Previous Application Made: [If yes,date___________________) No � New Construction: Yes Zj--No ❑i. FHA/VA; Yes ❑ No [)— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well-----------------Distance from foundation-----------___......Material-------------------- .__________.._.__.____-___-_. e - No. of compartments..---------- = •---------Size------•--------------------._..Liquid di?th-------------- -------Capacity----------- ------•-- Disposal Fi Id: Distance from nearest well-----------------Distance from foundation______________-----Distance to nearest lot line---------.-._____ �j NAer of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type4j of filter material-------------------------Depth of filter material----------------------- aegth------------.............................. _ R '� f is 4 - 6—f Seepage Pit: Distance to nearest well_.-cc ____-___Distance from foundation__ __ _________Distance to nearest lot line__.--___-_____..- Nurnr er of its------ ---------------Linin material.__ /-_..- ------Size: Diameter------- -----Depth---------Z_j___'.._------.. P � g --- Cesspool: DistAnce from nearest well-----------------Distance from foundation-------------------_Lining material-------------------..._____________--. ❑ Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------- Privy: Disteince from nearest well-----------------------------------_-------------Distance from nearest building------------------------------ ---_. Q ❑ Dist nce to nearest lot line-------------- _---r-= —:-- -� __ - - Remodeling and/or repairing (describe):--------- ---------------------------------------------•---------------------•--------. -•-•-- { -------------------------------------- -- ------------•-•-=---------------------•-- •--- --------------- ---------------------------------------------------------------..._ I i -----------------------------------------------------• --------------------------------------- hereby certify that-.I have prepared this applicat'on and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o San Joaquin Local Health District. --------------------------------------- --- - --------�---- ------------------------------ e"---• i (Signed)----------------• ------- - i � ,�_ --------------------------.{Owner and/or Contractor) BY=--------------------------------------------------- -------- --- -- ---- - --� - •-----------------------------"-'..'q....(Title)------------------- ----------- ------------- (Plot plan, showing size of'lot, location o ste relation to wells, buildings, etc., can be placed on reverse side). I• { FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY ----------------- -- -- - ------------------------------------- DATE-------- REVIEWED BY - ' --------------------------------------- DATE-------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------=--• ----------- DATE------------- •------- - ---------- Alterations and/or recommendations-----------------------------------------------------::....---------------•-••-•---------------.....- .... -- - •---------- � ------------------- -----•-------------------------------------------- - L --- -----•-•--------- --•------- --------------------------------- ---------- --------------------------------------•-----_-------- -----------------•-••----------- --------------- -- ---------------------------------------------- -------------------------- -•----- ------------------------------.---------------- ------------------------------------------------.. --------------- I FINAL INSPECTION BY------ J ---- - ------ -` -----_------------ Date--• - --------------------------_------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E6.9 REVIOtO 0.99 F.P.LO.2M 6.60